Primary Care Model Presentation to the Advisory Council September - - PowerPoint PPT Presentation

Primary Care Model

Presentation to the Advisory Council September 12, 2016

CONCEPT

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Guiding Principles

• Broad-based provider participation design- Patient Designated Provider
• Enhanced population health management functions
• All-payer, incrementally in alignment with Phase 2 of waiver
• Care Management as a necessary element, embedded where able
• Regional Care Coordination Resources
• All Payer Model/TCOC alignment including Duals
• Person and Family Centered base of care
• Aligned and consistent set of quality/outcome metrics
• Efficient data exchange and robust, connected tools for providers
• Financial and non-financial incentives to encourage practice

transformation

• Quality and cost transparency for providers and patients

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PATIENT (PT)

Maryland Primary Care Model

Patient-Designated Provider (PDP)

Care Management Resources & Infrastructure

Administrator (State Level) CRISP Resource Manager (Regional)

Hospital Chronic Care Initiative (CCIP)

High Risk Patients, Rising Risk Patients

PQI Bonuses

Traditional PCPs

Specialists Behavioral Health Providers SNF Providers Ambulatory Care Providers LTSS Providers Chronic HH Providers

Medicare + Medicaid + Commercial

Care Coordination Payments PDP embeds or requests unembedded CM resources based on PT need xx% CM Funds xx% CM Funds Quality Payments at Risk

(MACRA qualifying)

Visit/Non-Visit-based Payments

Population Health Mgmt/HIT

Person-Centered Home (PCH)

CM CM

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Key Elements of the Model

• Primary Care Home/ Patient-designated Provider –

– the most appropriate provider to manage the care of each patient, provides preventive services, coordinates care across the care continuum, and ensures enhanced access. Most often this is a PCP but may also be a specialist, behavioral health provider, or

• ther depending on patients health needs

– Practice – means an individual provider or group of providers that deliver care as a team to a panel of patients. Practices may span multiple physical sites in the community

• Care Coordination/Management Infrastructure – a multi-level structure that coordinates

care management for patients and ensures appropriate deployment of resources

• Incenting Value-based Care

– Payers

• CM Funding
• Quality Funding
• Upfront non-Visit based payments- facilitates alternative care delivery

– Hospitals - chronic Care bonus pool alignment with community

• Population Health Management/HIT – key data exchanged to all care participants through

CRISP, using tools and analytics for risk stratification, improved care, and efficient connection to other services

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PRACTICE TRANSFORMATION

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Driving Practice Transformation

Regional Care Management Organization Care Managers Practice Transformers/Transformation Programs Performance Data Person-Centered Home/Practice

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Practices & Marylanders

Aligned Financial Incentives Core Quality Metrics Performance Data Core Practice Functions Practice Transformation Resources & Agents Care Management Resources, infrastructure , & Agents

Practice Transfor- mation Network APCD eCQM tool, State agency metrics Risk Structures

CRISP HIE, CRISP ICN Services

ACOs Health Plans Care Management Infrastructure Care Coordination Payments Hospitals Quality Payments

Practice Transformation Design

Non-Visit- based Payments Customized CPC+ like design

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What/Who is Transforming the Practice?

Entities

• Coordinating Entity (CE) – serves as the financial and data management center for all Regional Care

Management entities including – Administers payments from payers to regional entity and person-centered homes – Runs program analytics including risk identification and stratification – Connects with various programs/model

• Regional entity (e.g. an ACO, RP, or CIN)

– Organizes, contracts, and deploys CM resources – Serves as transformation resource and Learning Network outlet – Provides access to medical and non-medical resources – Ensures continuity across providers and single CM for ease of experience for patient, utilizing CRISP and CE tools

• CRISP – state designated HIE that provides essential point of service information for care decisions, care

coordination data, population health management data, and other key information and connections Agents

• Care Managers - An individual with knowledge of community resources to address non-medical needs,

whose efforts are integrated with pharmacists, therapists, specialists and primary care; a trusted advocate who shares important data via CRISP in order to keep patients safe as they navigate across settings of care and different health systems

• Transformation agents and programs - the individual and entity (contracted) that takes the lead on

standard elements of transformation for practices, has staff and programs housed within the regional care management entities, and provides on-site technical assistance to practices

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CARE MANAGEMENT INFRASTRUCTURE

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Regional Care Management Organization at the Center

PCH

CM

PCH

CM

PCH

CM

Regional Care Management Organization Care Management Entities

Regional Partnerships Health Systems/Hospitals ACOs Health Plans Local Heath Departments Pharmacy entities Others Supply CMs

CRISP CE

RN LCSW CHW PharmD MA CNA

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Regional Care Management Services Regional Care Management Organization provides the following services: 1.Resource Deployment and Contracting a) Coordination of primary CM resources – embedded and non-embedded (RN, MA, etc) b) Second level of CM resources – non traditional care management resources (PharmD, CHW, etc) based on demand by primary care managers through a referral process 2.Practice transformation training and network 3.Direct delivery of services in the community, e.g., non-office based primary care for high utilizers using CRISP hot-spotting tools?? a) Align with HSCRC Care Coordination Infrastructure funding for Regional Partnerships and health systems to provide community based care coordination and population health 4.Real-time portal for provider of resource offerings 5.Interface with CRISP and Coordination Entity for timely data 12

PAYMENT FLOWS

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Funding the Primary Care Model

Care Redesign Care Management Funding Quality Payments Upfront- at risk Visit-based Payments Advance non visit and discounted FFS MACRA/Quality Payment Program – AAPM Bonus At risk

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